| National Provider Identifier [NPI]: | 1639103716 |
| Last Name Of The Provider | SHAH |
| First Name Of The Provider | NANDINI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9555 76TH STREET |
| Street Address 2 Of The Provider | |
| City Of The Provider | PLEASANT PRAIRIE |
| Zip Code Of The Provider | 53158 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 614 |
| Number Of Medicare Beneficiaries | 130 |
| Total Submitted Charge Amount | 75354 |
| Total Medicare Allowed Amount | 43257.45 |
| Total Medicare Payment Amount | 28014.56 |
| Total Medicare Standardized Payment Amount | 30229.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 54 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 2062 |
| Total Drug Medicare AllowedAmount | 973.87 |
| Total Drug Medicare PaymentAmount | 919.48 |
| Total Drug Medicare Standardized Payment Amount | 919.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 560 |
| Number Of Medicare Beneficiaries With Medical Services | 130 |
| Total Medical Submitted Charge Amount | 73292 |
| Total Medical Medicare Allowed Amount | 42283.58 |
| Total Medical Medicare Payment Amount | 27095.08 |
| Total Medical Medicare Standardized Payment Amount | 29309.59 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 68 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 111 |
| Number Of Male Beneficiaries | 19 |
| Number Of Non Hispanic White Beneficiaries | 114 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 107 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9824 |